Provider Demographics
NPI:1477956548
Name:TEAGUE, ERIN (PTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SEIFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295 BROKEN FENCE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9607
Mailing Address - Country:US
Mailing Address - Phone:303-601-6666
Mailing Address - Fax:303-447-3390
Practice Address - Street 1:3000 CENTER GREEN DR STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-413-9903
Practice Address - Fax:303-413-9907
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0013356OtherPTA LICENSE